Drug Index


Mechanism :

Nicardipine is a calcium channel blocker, which inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle without changing serum calcium concentrations. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. The effects of nicardipine HCl are more selective to vascular smooth muscle than cardiac muscle.

Indication :

  • Hypertensive crisis

Contraindications :

Nicardipine is contraindicated in patients with hypersensitivity to the drug, in patients with advanced aortic stenosis. Reduction of diastolic pressure in these patients may worsen rather than improve myocardial oxygen balance. Caution In liver impairment, extensively metabolised by liver. May cause decrease in GFR.

Dosing :

Not approved by FDA for pediatric use.
Continuous IV infusion initially 500 ng/kg/min followed by maintenance infusion of 1-4 mcg/kg/min.

Adverse Effect :

Commonly reported adverse effects are headache, flushing, tachycardia, palpitations, dizziness, rash, gum hyperplasia. May increase intracranial pressure.

Interaction :

Beta-blockers: May increase cardiovascular adverse effects.
Cimetidine: May increase nicardipine serum concentration.
Digoxin: May increase digoxin serum concentration; monitor digoxin levels and if necessary, reduce digoxin dose.
Rifampicin: Do not use together as effective levels of nicardipine may not be reached.
Bioavailability is increased if taken with grapefruit juice.
Fentanyl: Severe hypotension has been reported during fentanyl anesthesia with concomitant use of a beta-blocker and a calcium channel blocker.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function. Start with small doses
<10Dose as in normal renal function. Start with small doses

Dose in Patients undergoing Renal Replacement Therapies
CAPDUnlikely to be dialysed. Dose as in GFR<10 mL/min
HDNot dialysed. Dose as in GFR<10 mL/min
HDF/High fluxUnknown dialysability. Dose as in GFR<10 mL/min
CAV/VVHDUnknown dialysability. Dose as in GFR=10–20 mL/min

Hepatic Dose :

Use caution in patients with hepatic impairment or reduced hepatic blood flow. Start with the lowest dose and extend the dosing interval based on clinical response.
12/19/2023 01:06:57 Nicardipine
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